Liver failure due to metastatic melanoma: A case report

Table 1 Melanoma-associated acute liver failure cases

Ref.	Clinical presentation	History of cancer	Diagnosis method of liver disease	Treatment	Outcome
Current case	Diffuse abdominal pain, jaundice, hepatic encephalopathy; progressive ALF with multi-organ dysfunction	No prior cancer history; possible uveal melanoma based on visual symptoms; no autopsy	Liver biopsy; HMB-45-positive melanoma	Supportive ICU care (intubation, dialysis, vasopressors); considered for transplant until result of biopsy	Death on day 7
O’Neill et al[3], 2024	RUQ pain, myalgia, nausea, subjective fevers; fulminant ALF	Previously excised cutaneous melanoma (in situ) on upper back, 1 year prior	Histopathological diagnosis via core biopsy of left axillary lymph node (MART1, SOX10, HMB45-positive)	Dual immunotherapy (nivolumab + ipilimumab), IV terlipressin, ICU support	Death on day 17 post-presentation due to refractory encephalopathy and hepatorenal syndrome
Lee et al[4], 2022	Nausea, vomiting, RUQ and LUQ pain, dyspepsia; fulminant ALF	No known history of melanoma; presumed first presentation, later verified suspicious skin lesions	Liver biopsy (S-100, HMB45, MART1-positive); stomach biopsy supportive	Supportive care; no specific antitumor therapy reported	Death shortly after liver biopsy; multiple organ failure before workup for primary site completed
Schlevogt et al[7], 2017	Right flank pain; rapid deterioration to ALF with renal failure and encephalopathy	Malignant melanoma of right flank (3 years prior), recurrent cutaneous metastases; colorectal carcinoma resected 6 months prior	Liver biopsy (S100-positive; HMB45/MART1-negative)	BRAF-inhibitor (Vemurafenib) + MEK-inhibitor (Cobimetinib)	Death after one week 7 days; autopsy confirmed diffuse hepatic infiltration
Escobar-Valdivia et al[5], 2017	RUQ pain, jaundice, weight loss, blindness in left eye; rapid ALF with encephalopathy	Undiagnosed uveal (choroidal) melanoma; visual impairment to blindness over 2 months, history revealed pigmented eye lesion 1 year prior	Post-mortem histopathology (liver and eye); coagulopathy precluded biopsy ante-mortem	Supportive care (FFP, vitamin K); no tumor-directed therapy	Death from multiorgan failure 4th in-hospital day; confirmed metastatic uveal melanoma on autopsy
Tanaka et al[11], 2015	Left hand necrotic ulcer, erythema on trunk, no encephalopathy; later developed ALF	No known history of melanoma; diagnosed post-mortem as melanoma of unknown primary origin	Post-mortem histopathology and immunohistochemistry (HMB-45, S100-positive)	Palliative care; patient not eligible for systemic therapy due to poor performance status	Death on day 47; diffuse hepatic and splenic infiltration by melanoma confirmed on autopsy
Mashayekhi et al[12], 2014	Jaundice, abdominal pain, oliguria; rapid ALF with multiorgan failure	Suspicious skin lesion (mole on back) noted 10 days before admission, not yet diagnosed or treated	Post-mortem histopathology; liver, heart, lung, kidney, bladder infiltrated with melanoma	Supportive care (antibiotics, fluids, inotropes); no tumor-directed therapy before death	Death on day 3; widespread multiorgan metastatic melanoma confirmed on autopsy
Bellolio et al[10], 2013	Abdominal pain, jaundice, acholic stools, dark urine; rapid progression to fulminant hepatic failure	History of breast cancer treated 5 years prior; no known melanoma	Post-mortem histopathology; liver, spleen, and lymph nodes infiltrated with melanoma; HMB-45 and S-100-positive	Supportive care; rapid deterioration precluded biopsy or targeted therapy	Death shortly after admission; melanoma of unknown primary confirmed at autopsy
Tanaka et al[13], 2004	Malaise, anorexia, abdominal distension, edema; ALF and encephalopathy, death within hours	No prior history; melanoma of unknown primary origin diagnosed post-mortem	Post-mortem histopathology; massive hepatic infiltration, melanoma cells in mesenteric lymph nodes	Supportive care only; rapid deterioration precluded therapeutic intervention	Death on hospital day 7; massive liver involvement, no primary site found on autopsy
Montero et al[8], 2002	Jaundice, nausea, vomiting, general malaise; ALF with encephalopathy and renal failure	Supraciliary melanoma treated 18 months prior (Clark II, < 1 mm depth, negative margins)	Transjugular liver biopsy; diffuse sinusoidal infiltration by melanoma, HMB-45-positive	Standard liver failure therapy; no antitumor intervention	Death on day 10; progressive hepatic encephalopathy and renal dysfunction
Te et al[6], 1999	Nausea, vomiting, RUQ pain, malaise; fulminant hepatic failure with encephalopathy and renal failure	Scalp lesion biopsied 2 months prior; initially non-diagnostic, later confirmed as melanoma	Percutaneous liver biopsy (HMB-45, S-100-positive); scalp mass re-biopsy-confirmed melanoma	Supportive therapy; chemotherapy deferred due to rapid deterioration	Death within 24 hours of encephalopathy onset; extensive sinusoidal infiltration confirmed histologically
Bouloux et al[9], 1986	Hypochondrial pain, nausea, vomiting, jaundice, encephalopathy; rapid onset ALF and hepatorenal syndrome	Previously treated nodular melanoma (Clark IV, 5 mm depth) of right scapula; in situ melanoma of sacrum	Post-mortem histopathology; liver almost entirely replaced by melanoma, confirmed microscopically	Supportive care (vitamin K, neomycin, lactulose); no tumor-specific therapy given	Death on day 10; diffuse liver infiltration confirmed on autopsy

ALF: Acute liver failure; FFP: Fresh frozen plasma; HMB-45: Human melanoma black; ICU: Intensive care unit; INR: International normalized ratio; IV: Intravenous; LUQ: Left upper quadrant; MART1: Melanoma antigen recognized by T cells 1; RUQ: Right upper quadrant; SOX10: SRY-box transcription factor 10.